Following in the footsteps of other countries, Kazakhstan is set to implement a radical change within its healthcare sector, in particular health insurance. Its citizens are now obliged to obtain private health insurance instead of, or in addition to, a national health insurance scheme. Countries with a long history of insurance-based healthcare systems include Japan, the Netherlands, Australia, the US, and Switzerland.
The government introduced the new law in 2015 with the view of implementing the changes in July 2017; however, its enforcement has been moved back to January 1, 2018. Employers, nevertheless, started paying their contributions to the Health Insurance Fund (HIF) from January 1, 2017. The legislation is part of President Nazarbayev’s 2050 vision to make Kazakhstan one of the top-30 economies in the world. Currently, healthcare is arranged at the state, or oblast level, where each health department receives funding from the federal budget.
It is worth noting that Kazakhstan had previously attempted to introduce mandatory health insurance in 1996, but the insurance fund was liquidated shortly afterwards due to a corruption scandal involving the head of the fund and a failure by the executive bodies to pay contributions for the unemployed. This time, a number of measures will be implemented to ensure the financial stability of the fund, its transparency, and the management of its assets by the National Bank.
The government will be responsible for covering for the vulnerable segments of society and its contributions will increase to 7% of its budget until 2020. Employers, meanwhile, will pay their employees’ premiums, and from 2020 their contributions will reach 5% of income; employees and the self-employed will deduct 2% and 7%, respectively, from their personal incomes toward insurance premiums.
A direct consequence of mandatory insurance will be an increase in the demand for healthcare services, which in turn should raise the levels of competition between healthcare providers and subsequently increase the overall standards of Kazakhstan’s healthcare sector. As Elzhan Birtanov, Minister of Health, told TBY in an interview, the ultimate objective of the new policy is to improve healthcare in the country and to “keep the same or even higher level of quality and accessibility within limited sources to make the healthcare system more cost-effective.“ He added: “Under the current model, we are not incentivized to save money. If we receive KZT1 trillion, by law we have to spend it all.“ Birtanov also explained that patients will be able to avoid queues as insurance will cover access to private clinics, fully or partly, which will significantly decrease out-of-pocket spending, which will make the system more sustainable and will also attract the private sector, which is another opportunity for PPPs.
According to Manas Embergenovich, the head of the committee of payments of medical services in the Ministry of Health, the need for a new funding model for the sector stems from the fact that the provision of healthcare is expensive and governments cannot always guarantee free access for citizens. According to him, another important area of health insurance will be the development of primary healthcare, which is currently underdeveloped in Kazakhstan. “It is expected that these services will be accessible to every citizen of Kazakhstan, regardless of the region and place of residence,“ Embergenovich stated, adding that when patients decide to visit a doctor in the first place, they are guaranteed high-quality medical care.
Healthcare is indeed a basic social service that any country should make a priority as it moves towards sustainable development. There is no general consensus on whether one system is better than another, but Kazakhstan and the international community should welcome the country’s decision to eliminate current inefficiencies in healthcare and its efforts to radically change healthcare provision and make the country a better place for its citizens.